Glossary of Terms

Acute Stress Disorder (ASD)

For Experts

• Diagnostic criteria are provided for ASD in the DSM and ICD.
• A mental disorder that can occur after exposure to psychological stressors during one or more potentially psychologically traumatic events perceived as involving severe threat to self or others.
• Similar to Posttraumatic Stress Disorder, symptoms may include (but are not limited to):

1. 1. Recurrent involuntary memories or significant physiological reactions;
   2. Inability to feel positive emotions;
   3. Trouble remembering and avoidance of the psychologically traumatic event;
   4. Hyperarousal, and
   5. Sometimes persistent feelings of detachment.

• The experiences have lasted for three days or more but less than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The symptoms and signs are not better explained by another mental or physical health condition or the effects of a substance.
• Can evolve into Posttraumatic Stress Disorder and other types of psychological trauma.

For General Public

• Diagnostic criteria are provided for ASD in the DSM and ICD.
• A mental disorder that can happen after exposure to psychological stressors during specific types of severe, potentially psychologically traumatic events.
• Symptoms may include (but are not limited to): intrusive flashback memories of the event, inability to have positive feelings, trouble remembering the event, avoiding reminders of the event, disturbed sleep or being too vigilant, and sometimes feelings that things are unreal.
• Symptoms begin within one-month of experiencing the potentially psychologically traumatic event and may develop into Posttraumatic Stress Disorder after one month; however, Acute Stress Disorder is not a prerequisite for Posttraumatic Stress Disorder.
• The diagnosis of Acute Stress Disorder is made if the person’s condition is not better explained by another physical or mental disorder.

Adverse Childhood Experiences (ACE)

For Experts

• “Adverse childhood experiences are defined operationally as childhood events, varying in severity and often chronic, occurring in a child’s family or social environment that cause harm and distress, thereby disrupting the child’s physical or psychological health and development” (Kalmakis & Chandler, 2014). 
• Examples include, but are not limited to, exposure to emotional, physical or sexual abuse, emotional or physical neglect, intimate partner violence, or dysfunction within the household (e.g., exposure to parental separation, a family member with a history of mental disorders, substance use, incarceration, or suicide attempt).

For General Public

• Experiences of potentially psychologically traumatic events in a child’s family or social life that disrupt the health of child causing harm or distress.
• Includes, but not limited to emotional or physical neglect, emotional, physical or sexual abuse, or violence in the household. 
• Can predispose children to later life mental health conditions.

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Burnout

For Experts

• Currently a diagnosis in the ICD.
• Burnout is described by the World Health Organization as an “occupational phenomenon” and is included in the International Classification of Diseases (ICD-11). The ICD-11 defines Burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” “Burn-out refers specifically to phenomena in the occupational context and should not be applied to describe experiences in other areas of life,” (World Health Organization, 2018). 
• It is a “psychological syndrome in response to chronic interpersonal stressors on the job. The three key dimensions of this response are an overwhelming exhaustion, feelings of cynicism and detachment from the job, and a sense of ineffectiveness and lack of accomplishment” (Maslach, Leiter and Schaufeli, 2009). 
• Can also involve negative change in reaction to others, including depersonalization, inappropriate attitudes towards coworkers, irritability, loss of idealism, and withdrawal (Maslach, Leiter and Schaufeli, 2008). 
• Perceived “high caseloads, lack of control or influence over agency policies and procedures, unfairness in organization structure and discipline, low peer and supervisory support, and poor agency and on-the-job training” have been identified as organizational factors underlying Burnout (Barak, Nissly & Levin, 2001; Maslach & Leiter, 1997; Newell & MacNeil, 2010). 
• Distinct from compassion fatigue, vicarious stress, and vicarious trauma, because Burnout is not necessarily or exclusively related to exposures to potentially psychologically traumatic events, complex trauma, or adverse childhood experiences.

For General Public

• Currently a diagnosis in the ICD.
• A mental health condition that can occur when the person experiences ongoing occupational stress in the workplace, particularly organizational stress (e.g., ongoing conflict with supervisors or colleagues, high amounts of overtime; insufficient breaks).
• Might be occurring when the person seems to have one or more of the following: overwhelming exhaustion, is cynical, feels detached from the job, feels ineffective, or does not get rewards from working in the job.

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Compassion Fatigue

For Experts

• Currently not a diagnosis in the DSM or ICD.
• A mental health condition describing adverse psychological reactions in persons providing care to others, which is related to the stress experienced from caring, empathizing, and both the physical and psychiatric investments made when helping people who are suffering.
• Compassion fatigue can include a sense of helplessness, confusion, and a loss of compassion or empathy toward those one is treating or helping, as well as feelings of isolation from colleagues and usual social supports.
• Compassion fatigue can occur as a result of singular exposure or an accumulation of exposures to trauma.
• Sometimes associated with vicarious stress or vicarious trauma, but considered distinct from Burnout.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• A type of mental health condition that can occur in caregivers.
• Related to the stress of caring about other people who are in distress or who are suffering.
• Creates a sense of helplessness, confusion, or a loss of compassion and empathy for others, and feelings of being isolated from colleagues and other people.

Complex Posttraumatic Stress Disorder (C-PTSD)

For Experts

• Currently a diagnosis in the ICD.
• Meets all the diagnostic requirements for Posttraumatic Stress Disorder, with additional criteria, as specified in the ICD. 
• The main things that distinguish C-PTSD from Posttraumatic Stress Disorder are the protracted nature of the potentially psychologically traumatic event (e.g., exposure to a concentration camp), the subsequent distortions of the person’s sense of self and core personal and social identity, and significant emotional dysregulation. Posttraumatic Stress Disorder is more typically associated with a discrete traumatic event or set of traumatic events. 
• Described by Judith Herman (1992, 1995, 2015).

For General Public

• Currently a diagnosis in the ICD.
• A type of Posttraumatic Stress Disorder that results from repeated severe traumatic events that the person cannot escape usually as a result of adverse childhood experiences. 
• People with the condition have a profound loss of sense of identity and great difficulty controlling their emotions.

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Complex Trauma

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Psychological trauma resulting from exposure to multiple traumatic events or a single prolonged traumatic event, particularly when the event was difficult to escape, such as repeated childhood sexual or physical abuse, prolonged domestic violence, torture, slavery, genocide campaigns (Greeson, Briggs, Kisiel, Layne,  Ake, Ko, Gerrity, Steinberg, Howard, Pynoos, & Fairbank, 2011; Briere & Scott, 2015; National Child Traumatic Stress Network, 2019).
• Can result in mental health conditions, including but not limited to, Posttraumatic Stress Disorder and C-PTSD, depending on the severity of the response to the initial exposure.
• Often mistakenly used interchangeably with C- PTSD, but Complex Trauma would be a causal experience that may lead to C-PTSD.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Severe psychological trauma resulting from severe types of potentially psychologically traumatic events.
• Often used in conversations interchangeably with C-PTSD.

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Critical Incident

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Potentially psychologically traumatic events that are common among some groups, such as public safety personnel (PSP).
• Critical incidents were thought to involve experiencing unusually strong emotional reactions which have the potential to interfere with responders’ ability to function either at the scene or later and could include “all physical custody (arrests), all vehicle and foot pursuits, all dispatched code responses (emergency), all motor vehicle accidents that require physical work and all calls which present an active threat to life and/or property” (Mitchell, 1983, p. 36).
• “Critical incident” was used to distinguish common exposures in the line of duty from exposures thought more likely to be problematic.
• Available research suggests that individual perceptions, rather than a specific subset of potentially psychologically traumatic events, may be key determinants of whether a potentially psychologically traumatic exposure becomes problematic.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Potentially psychologically traumatic events that may be commonly experienced by public safety personnel (PSP), but that may nonetheless evoke unusually strong emotional reactions.
• May occur when a person is overwhelmed by the scope, severity, personal connection, or extent of exposure to a given potentially psychologically traumatic event.
• Often mistakenly used interchangeably with psychologically traumatic event or trauma.

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Diagnosis / Diagnostic

For Experts

• Diagnosis is the process of explaining a person’s state of mental or physical health through examination and consideration of various types of evidence.
• Diagnosis is also a conclusion made about the nature of a health condition, illness, or disorder. 
• Diagnostic criteria for making the diagnosis of a mental disorder include those listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD).
• The word diagnosis refers broadly to any justifiable conclusion made by a regulated health professional within their scope of practice, not just the formulations presented in the DSM or ICD.
• A diagnosis of a mental health condition should not be made without considering the differential diagnoses of physical health conditions that could alternatively explain the person’s state of health. Furthermore, physical health disorders also accompany mental disorders.

For General Public

• An explanation of a person’s mental or physical health made by a qualified health professional within their scope of practice. 
• The Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD) provide diagnostic criteria for mental disorders.

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First Responder(s)

For Experts

• The definition of “first responder” is continuing to evolve.
• A person with specialized training who is among the first to arrive and provide assistance at the scene of an emergency, such as an accident, natural disaster, or terrorist attack. Historically, first responders have traditionally included paramedics, emergency medical technicians, police officers, firefighters, and rescuers. 
• Other trained members of organizations connected with this type of work, including public safety communicators (e.g., 911 call centre personnel) and correctional officers, are also considered first responders.

For General Public

• The definition of “first responder” is continuing to evolve.
• A person with specialized training who is among the first to arrive and provide assistance at the scene of an emergency, such as an accident, natural disaster, or terrorist attack. Historically, first responders have included paramedics, police officers, special constables, firefighters, and rescuers. 
• Other trained members of organizations connected with providing professional assistance at the scene of an emergency (e.g., public safety communicators such as 911 personnel), may also considered first responders.

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Health

For Experts

• The physical, mental, social, and some say spiritual, functioning of a person, which can range from poor to good (Huber, 2010; Huber, Knottnerus, Green, van der Horst, Jadad, Kromhout … & Smid, 2011; Thompson, MacLean, Roach, Banman, Mabior & Pedlar 2016; Thompson, Heber, VanTil, Simkus, Carrese, Sareen & Pedlar, 2019). 
• Health can be described subjectively such as a person’s own description of their health, psychological well-being, or health-related quality of life.
• Health also can be described objectively, such as observations by a family member or health professional.

For General Public

• Refers to how a person is physically, mentally, socially, and spiritually functioning. 
• Can be described as how the person views their own health or as how others view a person’s health. 

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Interpersonal Violence

For Experts

• One or more behaviours wherein an individual causes physical trauma or psychological trauma to another individual, including but not limited to, child maltreatment, intimate partner violence, elder abuse, assault by strangers, as well as violence related to property crimes, in workplaces, and other institutions.
• Potentially traumatic events that involve interpersonal violence may cause more severe or complex mental health conditions (including mental disorders) due to interpersonal betrayal and attachment disruption. Other potentially psychologically traumatic stressors or events (e.g., natural disasters, structure fires) can also lead to similar severity and complexity of mental health conditions. However, the personal and relational nature of interpersonal violence often leads to more complex mental health conditions.

For General Public

• Harmful physical and psychological behaviour towards another person.
• A type of potentially psychologically traumatic event or stressor.
• Can contribute to mental health conditions in either the person causing the harm or the person who was harmed.
• Examples of interpersonal violence include intimate partner violence, elder abuse, and workplace violence.

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Mental Disorder

For Experts

• A clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects dysfunction in the psychological, biological, or developmental processes underlying mental functioning where the person’s condition meets DSM or ICD diagnostic criteria.
• Associated with significant distress in social, occupational, or other activities.
• Causes of mental disorders are thought to be multiple and interlinked, not linear, and related to various combinations of traumatic events or potentially psychologically traumatic events, genetics, biology, diet, socioeconomic factors, physical health conditions, physical environmental factors, and others. 
• The symptoms and signs are not better explained by a physical health condition or the effects of a substance.
• Common, culturally consistent responses to a common stressor or loss, such as the death of a loved one, which do not meet accepted diagnostic criteria, are not mental disorders. 
• Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual which meets accepted diagnostic criteria.

For General Public

• A type of mental health condition that meets accepted criteria for diagnosis published in the DSM or ICD.
• Criteria for diagnosis include impaired functioning in social, workplace, or other activities.
• A diagnosis of a mental disorder might be made if the diagnostic criteria best explain a person’s current condition.
• Mental disorders are thought to be caused by the interactions of different combinations of factors; for example,  potentially psychologically traumatic events or stressors, genetics, biology, socioeconomic factors, physical health conditions, or physical environmental factors.
• A person could receive a diagnosis of more than one mental disorder at a time.
• Does not include normal responses to common stressors like the loss of a loved one, workplace pressures, living with a physical health condition, or chronic pain.
• Mental disorder is currently the preferred term instead of mental illness.

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Mental Health

For Experts

• “Mental” refers to thoughts (thought content), feelings (emotions), and related brain functioning.
• Mental health varies on a continuum from “poor” to “good”. Good mental health is a state of psychological well-being. Good mental health generally enables people to function, realize their abilities, cope with the normal stresses of life, and contribute to their community. 
• Mental disorder severity lies on a different continuum from mental health and varies from mild to severe (Keyes, 2010). A person can have good mental health even though they have a mental illness or a mental disorder. Conversely, but more commonly, a person can have poor mental health but still not meet the diagnostic criteria for any specific mental disorder as described in the DSM or the ICD.
• Mental health is influenced by a wide variety of determinants, not only potentially psychologically traumatic events and stressors.

For General Public

• Refers to a person’s thoughts and feelings.
• Mental health exists on a continuum between poor and good. In good mental health, a person knows their abilities, copes well with normal stress, works well, and contributes to their community.
• People with a diagnosis of a mental disorder can be coping well and still have good mental health.
• On the other hand, a person can have poor mental health without having a diagnosis of a mental disorder.
• Mental health is influenced by a wide variety of factors, not only potentially psychologically traumatic events and stressors.

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Mental Health Injury / Psychological Injury

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Refers to any type of mental disorder, not only those that occur as a result of exposure to one or more potentially psychologically traumatic events.
• Injury means an acute state, not chronic states that can occur as a result of a physical or psychological trauma; however, colloquially injury can also mean a chronic state arising from an acute injury, for example, an operational stress injury.
• Commonly used to manage the stigma with associated language like mental disorder. 
• Mental disorders or other mental health conditions often are caused by mechanisms other than exposure to a psychologically traumatic stressor. Examples include mental disorders such as major depressive disorder, anxiety disorders, personality disorders, schizophrenia, or other psychotic disorders.

For General Public

• Mental health injury and psychological injury are alternative ways of referring to mental health conditions, including mental disorders, especially when the mental health conditions or mental disorders are thought to be caused by exposure to potentially psychologically traumatic events and other stressors.
• Mental health injury and psychological injury are not diagnostic categories in the DSM or ICD manuals.
• The word “injury” has been used in efforts to destigmatize mental disorders, especially posttraumatic stress disorder.

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Mental Health Condition/Mental Health Challenge

For Experts

• Broad term that includes mental disorders, mental illness, and undiagnosed symptoms that could be explained by mental disorder diagnoses. 
• Also includes states of poor mental health that do not meet DSM or ICD diagnostic criteria for mental disorders, including, for example, culturally consistent responses to common stressors and socially deviant behaviours where the person is functioning well.
• Some people prefer to use mental health challenge instead of mental health condition in an effort to reduce stigma.

For General Public

• Any state of poor mental health.
• Includes normal reactions to everyday stressors, as well as mental disorders.
• Some people prefer to use mental health challenge instead of mental health condition in an effort to reduce stigma.

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Mental Illness

For Experts

• When used, refers to mental disorders, diagnosed or as yet undiagnosed.
• Ranges in severity from mild to severe.
• Associated with significant distress in social, occupational, or other activities.

For General Public

• When used, refers to mental disorders, diagnosed or as yet undiagnosed.
• Ranges in severity from mild to severe.
• Associated with significant distress in social, occupational, or other activities.

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Moral Injury

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Evolving concept that continues to be discussed among experts. 
• One view is that moral injury is a type of psychological trauma characterized by intense guilt, shame, and spiritual crisis. 
• Can result from experiencing a significant violation of deeply held moral beliefs, ethical standards, or spiritual beliefs, experiencing a significant betrayal, or witnessing trusted individuals committing atrocities. 
• Has been described as an injury to one’s identity (Nash, 2016), core being, spirit, and sense of self that results in fractured relationships (Brémault-Phillips et al. 2019).

For General Public

• Currently not a diagnosis in the DSM or ICD manuals. 
• The concept of moral injury is still being debated by experts.
• Thought to be a type of mental health condition that results from a violation of deeply held beliefs and moral values.
• Has been described as an injury to one’s identity, core being, spirit, and sense of self that results in fractured relationships.

Occupational Stress Injury / Organizational Stress Injury

For Experts

• Currently not diagnosis in the DSM or ICD.
• Evolving concepts that continue to be discussed among experts. 
• One view is that occupational stressors sort into operational stressors and organizational stressors; however, the terms are emerging, and definitions remain unclear.
• To avoid confusion, the acronym “OSI” should be reserved for operational stress injury.

For General Public

• Currently not diagnosis in the DSM or ICD.
• One view is that occupational stressors can be classified into either operational or organizational stressors; however, the terms are emerging and definitions remain unclear.
• Often mistakenly used interchangeably with operational stress injury; therefore, wherever possible, use the acronym OSI only for operational stress injury and always be specific if referring to occupational stress injury, organizational stress injury, or operational stress injury.

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Operational Stress Injury (OSI)

For Experts

• Currently not a diagnosis in the DSM or ICD manuals.
• Currently used primarily in Canada.
• Originally defined as any mental disorder or other mental health condition resulting from operational duties performed while serving in the Canadian Armed Forces. 
• Used to describe a broad range of conditions including mental disorders such as anxiety disorders, depressive disorders, and Posttraumatic Stress Disorder, as well as mental health conditions that may not meet DSM or ICD criteria for mental disorders but still interfere with daily functioning in social, work or family activities. 
• The term was coined by Canadian Lieutenant Colonel (Retired) Stéphane Grenier as part of a broad effort to decrease the stigma associated with other language (e.g., mental disorder, mental health condition) by categorizing mental health conditions as “injuries” that are as legitimate as physical injuries sustained during operational duties. 
• Contemporary use refers to any mental disorder or other mental health condition resulting from operational stressors experienced while serving in a professional capacity, especially in military or other public safety professions. 
• Generally, the operational stressors associated with an operational stress injury typically refer to potentially psychologically traumatic events; however, in some cases, operational stress also refers to less severe elements of occupational duties (e.g., shift work, overtime, upholding a “higher image” in public). 
• Occasionally, operational stress injury is mistakenly used synonymously with organizational stress injury or occupational stress injury; however, operational stress, organizational stress, and occupational stress have all been defined differently in the current literature. 
• Organizational stressors may include staff shortages, lack of training on new equipment, lack of appropriate resources, inconsistent leadership styles, and a perceived lack of support between co-workers and leaders. 
• “Occupational stressors” has been used to refer broadly to both operational and organizational stressors. 
• Currently, only operational stress injury has been defined and used with any regularity by members of the mental health community.

For General Public

• Currently not a diagnosis in the DSM or ICD manuals.
• Refers to any mental disorder or other mental health condition resulting from operational stressors experienced (any level of severity) while serving in a professional capacity, especially in military or other public safety professions. 
• Often mistakenly used interchangeably with occupational stress injury or organizational stress injury; therefore, wherever possible, use the acronym OSI only for operational stress injury and always be specific if referring to occupational stress injury, organizational stress injury, or operational stress injury.

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People with Lived Experience / Experts by Experience

For Experts

• People who are living with, have lived with, or are recovering from a mental disorder or mental health condition.
• May also include persons exposed to a potentially psychologically traumatic stressor or event.
• May also include the loved ones or other supporting persons who are engaged with people who are living with, have lived with, or are recovering from a mental disorder or mental health condition or exposed to potentially psychologically traumatic stressor or event.

For General Public

• People who are living with, have lived with, or recovering from a mental disorder or mental health condition.

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Posttraumatic Growth (PTG)

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Refers to positive personal changes that may result from an individual working to cope with the psychological consequences of exposure to trauma or a potentially psychologically traumatic event.
• Major dimensions of posttraumatic growth include: enhancement of relationships (e.g., increases in empathy, humility, and altruism); changes in self-perception (e.g., of personal resiliency, strength; increased acceptance of vulnerability and limitations); changes in life philosophy (e.g., re-evaluating what’s important); and spiritual or existential change (Tedeschi, Park & Calhoun, 1998; Tedeschi, Calhoun, & Groleau, 2015).
• Posttraumatic growth is not merely bouncing back to pre-trauma levels of functioning, but positive growth beyond pre-trauma levels of functioning. 
• Posttraumatic growth and posttraumatic stress can occur within the same person at the same time.

For General Public

• Currently not a diagnosis in the DSM or ICD manuals.
• Generally refers to the positive personal changes that may result from an individual’s struggle to manage the consequences of being exposed to one or more potentially psychologically traumatic events.
• The positive personal changes may include such things as a new appreciation for life and future possibilities, a newfound sense of personal strength, improved relationships with others (e.g., a new focus on helping others), and spiritual or existential change.
• Posttraumatic growth is not merely bouncing back to pre-trauma levels of functioning, but positive growth beyond pre-trauma levels of functioning.

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Posttraumatic Stress (PTS)

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Has been used to refer to stress and/or mental health conditions arising from exposure to a potentially psychologically traumatic stressor or event.
• Has been used to refer specifically to Posttraumatic Stress Disorder, but has also been used to refer to mental health conditions with some features of Posttraumatic Stress Disorder that do not meet criteria for the diagnosis of Posttraumatic Stress Disorder but still interfere with daily functioning in social, work, or family activities.
• Can develop soon after exposure to a potentially psychologically traumatic event or progressively over time with cumulative exposures.                    
• Does not refer to reactions to stressful events or significant life changes that are not potentially psychologically traumatic stressors/events, so does not refer to normal reactions to common stressors.
• Often mistakenly used interchangeably with other terms such as posttraumatic stress disorder; therefore, wherever possible, using another more specific term will be more accurate and more helpful.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Has been used to refer to stress and/or mental health conditions from exposure to a potentially psychologically traumatic stressor or event.
• Has been used to refer specifically to Posttraumatic Stress Disorder, but has also been used to refer to mental health conditions that follow exposure to a potentially psychologically traumatic event and interfere with daily functioning in social, work, or family activities.
• Often mistakenly used interchangeably with several other terms; therefore, wherever possible, using another more specific term will be more accurate and more helpful.

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Posttraumatic Stress Disorder (PTSD)

For Experts

• Diagnostic criteria are provided for Posttraumatic Stress Disorder  in the DSM and ICD.
• A mental disorder which can occur following exposure to specific types of severe, potentially psychologically traumatic events perceived as involving severe threat to self or others. 
• Symptoms can include:

1. 1. Intrusive involuntary memories, flashbacks, nightmares, or distress on exposure to triggers of the traumatizing event;
   2. Avoidance of reminders of the traumatizing event;
   3. Persistent, event-related negative moods and thoughts like fear, mistrust, shame, or detachment; 
   4. Sleep disturbance, hypervigilance, startle response, irritability, or anger; and
   5. Sometimes significant dissociation, with amnesia or decreased responsiveness to external stimuli.

• The experiences last for more than one month and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The symptoms and signs are not better explained by another mental or physical health condition or the effects of a substance.

For General Public

• Diagnostic criteria are provided for Posttraumatic Stress Disorder  in the DSM and ICD.
• A mental disorder that can happen after exposure to psychological stressors during specific types of severe, potentially psychologically traumatic events.
• Posttraumatic Stress Disorder may involve different combinations of sleep disturbances, flashbacks, triggers, regular vivid recall, intrusive memories, avoiding reminders of the psychologically traumatic event and avoiding thinking about the psychologically traumatic event, trouble remembering parts of the psychologically traumatic event, persistently negative thoughts, low mood, anger, feeling emotionally numb and, having difficulties feeling emotionally connected to family or close friends.
• The experiences last for more than one month and cause significant distress and/or impairment in social, occupational, or other important areas of functioning.
• The diagnosis of Posttraumatic Stress Disorder is made if the peson’s condition is not better explained by another physical or mental disorder.

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Posttraumatic Stress Injury (PTSI)

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Currently used primarily in Canada.
• Refers to a mental health condition that a person might acquire as a result of exposure to one or more potentially psychologically traumatic events.
• Used to describe a range of problems including, but not limited to, mental disorders such as Posttraumatic Stress Disorder and mental health conditions that may not meet DSM or ICD criteria for Posttraumatic Stress Disorder that still interfere with daily functioning in social, work or family activities. 
• By categorizing mental health conditions as “injuries” that are as legitimate as physical injuries, the term can decrease the stigma associated with language such as mental disorder or mental health condition.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Currently used primarily in Canada to decrease the stigma associated with the word “disorder”. 
• Currently, the term is most often used within the military and public safety personnel communities in Canada.
• Refers to a mental health condition that a person acquires as a result of exposure to one or more potentially psychologically traumatic events.
• Has been used by some people to refer to Posttraumatic Stress Disorder, but has also been used by some people to refer to several other mental disorders.

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Posttraumatic Stress Syndrome (PTSS)

For Experts

• Currently not a diagnosis in the DSM or ICD.
• May be considered inaccurate or stigmatizing.
• Often mistakenly used interchangeably with several other terms; therefore, wherever possible, using another more specific term will be more accurate and more helpful. 
• See also posttraumatic stress injury, Posttraumatic Stress Disorder, posttraumatic stress.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• May be considered inaccurate or stigmatizing.
• Often mistakenly used interchangeably with several other terms; therefore, wherever possible, using another more specific term will be more accurate and more helpful.
• See also posttraumatic stress injury, Posttraumatic Stress Disorder, posttraumatic stress.

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Psychological Trauma / Psychologically Traumatic Injury / Psychologically Traumatized

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Trauma caused by exposure to psychologically traumatic event (Briere & Scott, 2015; Substance Abuse and Mental Health Services Administration, 2019).
• The manifestations of the traumatic injury may be consistent with one or more mental disorders, but may also be consistent with mental health conditions for which there are no diagnostic categories in the DSM or ICD.
• Psychological trauma is a unique, individual experience. 

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Any mental disorder or other mental health condition resulting from exposure to a psychologically traumatic event.
• Psychological trauma is a unique, individual experience that may not present the same way for every person.
• See also mental disorder, mental health injury, posttraumatic stress injury, Posttraumatic Stress Disorder, Acute Stress Disorder.

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Psychologically Traumatic Event / Psychologically Traumatic Stress / Psychologically Traumatic Stressor

For Experts

• A psychologically traumatic event is a stressful event that may cause psychological trauma.
• Exposure to certain types of psychologically traumatic events are included in the DSM and ICD criteria for the diagnosis of Acute Stress Disorder or Posttraumatic Stress Disorder. 
• The terms are often preceded by the word “potentially” to underscore the importance of individual perception within a specific context when determining whether an event is a psychologically traumatic stressor.
• Examples include significant threats of harm to the self or loved ones, exposure to war as a combatant or civilian, threatened or actual physical assault, threatened or actual sexual violence, being kidnapped, being taken hostage, torture, natural or human-made disasters, or other mechanisms of severe physical injuries such as motor vehicle accidents and industrial accidents.
• Exposure to a potentially psychologically traumatic stressor can be direct (e.g., happened to me; witnessed it first hand) or indirect/vicarious/secondary (e.g., witnessed the aftermath; learned about the trauma happening to a loved one, or as part of providing support or care to another person, either professionally or personally).
• Not everyone exposed to a potentially psychologically traumatic event or stressor develops psychological trauma.
• Most critical incidents would be potentially psychologically traumatic events, but not all potentially psychologically traumatic events would be critical incidents.

For General Public

• Things that can cause psychological trauma like Posttraumatic Stress Disorder and other types of mental health conditions. 
• The terms are often preceded by the word “potentially” to underscore the importance of individual perception within a specific context when determining whether an event is a psychologically traumatic stressor.
• There is often an element of significant threat to the physical safety of the self or others that may be associated with feelings of intense fear, horror, or helplessness.
• Examples may include some adverse childhood events, motor vehicle accidents, sexual and other types of violence, unexpected death or threat of death of loved ones, severe physical injury, military combat, natural disasters, or exposure to bodies or environmental hazards.
• Most critical incidents would be potentially psychologically traumatic events, but not all potentially psychologically traumatic events would be critical incidents.

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Public Safety Personnel (PSP)

For Experts

• The definition of “Public Safety Personnel” (PSP) is continuing to evolve.
• Currently used primarily in Canada. 
• Broad term meant to encompass personnel who ensure the safety and security of Canadians. 
• PSP include, but are not limited to, border services officers, public safety communicators, correctional workers, firefighters (career and volunteer), Indigenous emergency managers, operational intelligence personnel, paramedics, police (municipal, provincial, federal), and search and rescue personnel.
• History:

1. 1. In the 2016 Standing Committee on Public Safety and National Security Report, “Healthy minds, safe communities”, Public Safety Canada defined a “Public Safety Officer” as a broad term meant to encompass front-line personnel who ensure the safety and security of Canadians, including first responders / tri-services (i.e., firefighters, paramedics, police), search and rescue personnel, correctional services officers, border services officers, operational intelligence personnel, and Indigenous emergency managers.
   2. Feedback regarding the word “officer” in the term “Public Safety Officer” indicated many professional groups intended to be included felt excluded because they did not identify as officers; as such, the term PSP has been adopted to reference persons acting in professional capacities to fulfill public functions with duties related to public safety.

For General Public

• The definition of public safety personnel (PSP) is continuing to evolve. 
• All first responders can also be referred to as PSP.
• Broad term meant to include personnel who ensure the safety and security of Canadians. 
• PSP include, but are not limited to, border services officers, public safety communicators, correctional workers, firefighters (career and volunteer), Indigenous emergency managers, operational intelligence personnel, paramedics, police (municipal, provincial, federal), and search and rescue personnel.

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Recovery

For Experts

• There is no universally agreed definition for this term, however, the concept is widely endorsed.
• Refers to the personally contextualized, self-determined journey to good well-being when a person has a mental disorder, a chronic physical health condition, or chronic pain. 
• An ongoing process of change that increases the person’s well-being, including symptom reduction but also living a meaningful life where the person has positive mental health, is hopeful and optimistic, and is participating and contributing (Mental Health Commission of Canada, 2017; College of Family Physicians of Canada, 2018).

For General Public

• The personalized journey to a way of living that allows a person with a physical or mental health condition to have positive mental health and good well-being.

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Resilience

For Experts

• Generally used to describe the concept of adapting to or bouncing back from a negative event or experience. 
• Defined in a number of different ways as something one has, something one develops, or something one uses, which reflects a lack of consensus over the specific qualities or components that make up resilience.
• Can refer to the resilience of individuals but can also refer to the resilience of groups (e.g., families, teams, organizations).
• Resilience has been used to describe the ability to adapt and maintain, or return to previous levels of good well-being in individuals or groups (e.g., families, teams, organizations).
• Resilience may be influenced by factors internal to individuals and by factors created by groups (e.g., families, teams, organizations).
• Resilience is not constant, but may vary over time due to internal and/or external factors.

For General Public

• A person’s ability to adapt to challenges or bounce back after a bad experience.
• This ability can be further supported or undermined by the groups to which a person belongs (e.g., by their families, teams, organizations).

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Stress / Stressor / Stressful Event 

For Experts

• Stress describes the experience a person has while being impacted by one or more stressors, often characterized by psychological distress and physiological changes (e.g., increased heart rate, shallow breathing, muscle tension).
• Stress is a common experience and some stress can be a good thing if the stress leads to growth and adaptation; however, stress can result in psychological trauma.
• A stressor is a physical, radiological, biological, socioeconomic, or psychological force that acts upon a person during events such as a motor vehicle accident, loss of an important relationship, loss of employment, confronting an attacker, dealing with financial loss, or adverse childhood experiences.
• A psychologically stressful event is an episode in time during which a stressor operates on a person and causes an emotional experience accompanied by predictable biochemical, physiological, and behavioural changes.
• Confusingly, the word stress is often used synonymously, sometimes mistakenly, when people are referring to traumatic stress, psychological trauma, a mental health condition, or a mental disorder associated with experiencing a stressful event.
• Stress, stressor, and stressful event are often used interchangeably to refer to a potentially psychologically traumatic event or an adverse childhood experience.

For General Public

• Stress means the way a person feels or looks when they are affected by a stressor. 
• Stress is a common experience and some stress can be a good thing if the stress leads to growth and adaptation; however, stress can result in psychological trauma.
• A stressor is something that puts pressure on a person physically or mentally.
• A person experiencing a stressful event is being impacted by one or more stressors that are causing them to experience stress. If the experience is severe enough, stress may result in a psychological trauma that can lead to a mental health condition, such as Posttraumatic Stress Disorder.
• Confusingly, the word stress often is used interchangeably, sometimes mistakenly, when people are referring to traumatic stress, psychological trauma, a mental health condition, or a mental disorder associated with experiencing a stressful event.
• Stress, stressor, and stressful event, are often used interchangeably to refer to a potentially psychologically traumatic event or an adverse childhood experience.

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Trauma / Traumatic Injury

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Trauma can be (a) physical, meaning an injury to living tissue caused by an extrinsic physical, biological, or radiological agent, or (b) psychological, meaning a disordered psychic or behavioural state resulting from severe mental or emotional stress.
• In the mental health context, trauma is a person’s experience during an event so distressing to them that it overwhelms them emotionally. Severe psychological trauma is viewed as the etiology (cause) of Posttraumatic Stress Disorder.
• A person can experience physical trauma without also experiencing psychological trauma, as in minor physical trauma that causes a minor laceration, sprain, skin infection, or sunburn. On the other hand, severe physical trauma that causes unstable multi-organ system polytrauma usually is associated with psychological trauma. It has been hypothesized that physical trauma to the central nervous system, such as penetrating or blunt force traumatic brain injury, can also contribute causally to psychiatric sequelae like Posttraumatic Stress Disorder.
• Psychologically stressful experiences are not necessarily traumatic. People can feel stressed without experiencing trauma.
• Injury means an acute state, not chronic states that can occur as a result of a physical or psychological trauma. However, colloquially injury often is used to describe a chronic state arising from an acute injury, for example, an operational stress injury.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• “Trauma” is something that causes physical, emotional, spiritual, or psychological harm. In the mental health context, trauma is a person’s own experience during an event so distressing to them that it overwhelms them emotionally.
• In the mental health context, psychological trauma is viewed as the cause of a mental disorder like Posttraumatic Stress Disorder.
• Psychologically stressful experiences are not necessarily traumatic. People can be feel stressed without experiencing trauma.

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Traumatic Event / Traumatic Stress / Traumatic Stressor

For Experts

• Currently not a diagnosis in the DSM or ICD.
• In the context of mental health discussions, usually refers to a potentially psychologically traumatic event.
• The DSM and ICD specify the types of potentially psychologically traumatic events that serve as criteria for a diagnosis of Posttraumatic Stress Disorder. (For details, see Psychologically Traumatic Event).
• For clarity, the word “psychological” or “physical” should be used, as in “physically traumatic event” or “potentially psychologically traumatic event,” since not all potentially psychologically traumatic events cause physical trauma, and physically traumatic events are not necessarily psychologically traumatic.

For General Public

• Currently not a diagnosis in the DSM or ICD.
• In the context of mental health discussions, usually refers to a potentially psychologically traumatic event.
• Using these terms without specifying “psychologically” or “physically” can cause confusion about the nature of the potentially traumatic stress or event.

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Tri-Services

For Experts

• A subset of public safety personnel.
• Refers specifically to firefighters, paramedics, and police.

For General Public

• Public safety personnel who are firefighters, paramedics, and police.

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Vicarious Traumatic Stress

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Stress that can occur following indirect exposure to a potentially psychologically traumatic event being exposed to a traumatized person (e.g., witnessed the aftermath; learned about the trauma happening to a loved one; or as part of providing support or care to another person, either professionally or personally).

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Stress that a person feels when they learn about trauma experienced by another person.

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Vicarious Traumatization

For Experts

• Currently not a diagnosis in the DSM or ICD.
• Psychological trauma that occurs following indirect exposure to a potentially psychologically traumatic event or being exposed to a traumatized person (e.g., witnessed the aftermath; learned about the trauma happening to a loved one; or as part of providing support or care to another person, either professionally or personally).
• It can be “the transformation that occurs within the therapist as a result of empathic engagement with client’s trauma experiences and their sequelae” (Pearlman & Mac Ian, 1995). 
• Has been conceptualized as being exacerbated by, and perhaps even rooted in, the open engagement of empathy, or the connection with the client that is inherent in counselling relationships (Pearlman & Saakvitne, 1995b; Trippany, Kress, & Wilcoxon, 2004).
• Reflects exposure of counsellors to client’s traumatic material and encompasses the subsequent cognitive disruptions experienced by counsellors (Figlet, 1995; McCann & Pearlman, 1990; Trippany, Kress, & Wilcoxon, 2004). 

For General Public

• Currently not a diagnosis in the DSM or ICD.
• Psychological trauma that can occur in people who are indirectly exposed to a potentially psychologically traumatic event (e.g., witnessed the aftermath; learned about the trauma happening to a loved one; or as part of providing support or care to a traumatized person, either professionally or personally).

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Well-being (Wellbeing)

For Experts

• There are many ways of understanding the term “well-being,” and there is no universal standard for spelling well-being with a hyphen or wellbeing without a hyphen.
• Psychologists often talk about forms of subjective psychological well-being, like happiness or quality of life. Economists talk about forms of objective well-being, like gross national product or household income. Recently, researchers worldwide have begun to think of well-being in broader terms that encompass all the different types of well-being. 
• Veterans Affairs Canada (VAC) and the Canadian Armed Forces (CAF) describe well-being using a broad framework that includes seven interacting domains: 

1. 1. employment/purposeful activity;
   2. finances; 
   3. health/disability;
   4. life skills/preparedness;
   5. social integration; 
   6. housing/physical environment, and;
   7. cultural/social environment. The cultural/social environment includes a diverse range of factors like values, norms, and healthcare and other social security systems.  Elements of each domain in this framework can vary from poor to good based on subjective and objective measurements (Thompson, MacLean, Roach, Banman, Mabior & Pedlar 2016; Thompson, Heber, VanTil, Simkus, Carrese, Sareen & Pedlar, 2019).

• In the VAC-CAF type of well-being framework, health is one domain of well-being that can interact with the other domains to impact well-being; for example, having a good job supports good mental health, but it is equally true that having good mental health supports finding and keeping a good job.
• The subjective and objective variability from poor to good in each domain underscores the complexity of well-being and the importance of understanding health as part of a system with bidirectional causality, rather than something that operates in isolation.

For General Public

• There are many ways of understanding the term “well-being.”
• Examples include psychological well-being like happiness or quality of life, or economic well-being like household income or gross national product.
• Veterans Affairs Canada (VAC) and the Canadian Armed Forces (CAF) describe well-being using a broad framework that includes all ways of thinking about well-being across seven interacting domains: 

1. 1. employment/purposeful activity; 
   2. finances;
   3. health and abilities; 
   4. life skills/preparedness; 
   5. social integration; 
   6. housing/physical environment, and;
   7. cultural/social environment, which includes things like norms, values, healthcare, and other support services.

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Wellness

For Experts

• Many people and agencies have different understandings of the word “wellness.” 
• The First Nations Mental Wellness Continuum Framework (FNMWCF) defines mental wellness as a balance of the mental, physical, spiritual, and emotional (Health Canada and Assembly of First Nations, 2014). This balance is enriched when individuals have: Purpose in their daily lives whether it is through education, employment, caregiving activities, or cultural ways of being and doing; Hope for their future and for those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of Belonging and connectedness within their families, to community, and to culture; and finally, a sense of Meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history. 
• There has been much overlap between the words “wellness,” “health,” and “well-being,” including using the words interchangeably. 
• The Veterans Affairs Canada well-being framework enables separation of words this way:

1. 1. Well-being: defined as in the VAC composite, superordinate type of framework.
   2. Health: a domain of well-being, influenced by and influencing well-being in the other domains.
   3. Wellness: ways of living to achieve good well-being, particularly in the health domain.

For General Public

• Many people and agencies have different understandings of the word “wellness.” It is unlikely that a consensus definition is possible at this time.
• The First Nations Mental Wellness Continuum Framework (FNMWCF) defines mental wellness as a balance of the mind, body, soul, and emotions. In this framework, mental wellness is enriched when a person has purpose, hope for their future, a sense of belonging, and a sense of meaning.

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